Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-13T20:39:02.788Z Has data issue: false hasContentIssue false

A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients

Published online by Cambridge University Press:  05 May 2021

D. A. Brent*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
J. Grupp-Phelan
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
B. A. O'Shea
Affiliation:
Department of Psychology, Harvard University, Cambridge, Massachusetts, USA Department of Psychology, University of Amsterdam, Netherlands
S. J. Patel
Affiliation:
Departments of Emergency Medicine and Trauma Services at the Children's National Health System, USA
E. M. Mahabee-Gittens
Affiliation:
Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
A. Rogers
Affiliation:
Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
S. J. Duffy
Affiliation:
Departments of Emergency Medicine and Pediatrics at the Alpert Medical School at Brown University, USA
R. P. Shenoi
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
L. S. Chernick
Affiliation:
Department of Emergency Medicine, Columbia University, New York, NY, USA
T. C. Casper
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
M. W. Webb
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
C. A. King
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
*
Author for correspondence: D. A. Brent, E-mail: brentda@upmc.edu

Abstract

Background

Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.

Methods

A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.

Results

A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).

Conclusions

In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barnes, S. M., Bahraini, N. H., Forster, J. E., Stearns-Yoder, K. A., Hostetter, T. A., Smith, G., … Nock, M. K. (2017). Moving beyond self-report: Implicit associations about death/life prospectively predict suicidal behavior among veterans. Suicide & Life-Threatening Behavior, 47(1), 6777. doi: 10.1111/sltb.12265.CrossRefGoogle ScholarPubMed
Cha, C. B., Augenstein, T. M., Frost, K. H., Gallagher, K., D'Angelo, E. J., & Nock, M. K. (2016). Using implicit and explicit measures to predict nonsuicidal self-injury among adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 55(1), 6268. doi: 10.1016/j.jaac.2015.10.008.CrossRefGoogle ScholarPubMed
Cha, C. B., O'Connor, R. C., Kirtley, O., Cleare, S., Wetherall, K., Eschle, S., … Nock, M. K. (2018). Testing mood-activated psychological markers for suicidal ideation. Journal of Abnormal Psychology, 127(5), 448457. doi: 10.1037/abn0000358.CrossRefGoogle ScholarPubMed
Conway, P. M., Erlangsen, A., Teasdale, T. W., Jakobsen, I. S., & Larsen, K. J. (2017). Predictive validity of the Columbia-suicide severity rating scale for short-term suicidal behavior: A Danish study of adolescents at a high risk of suicide. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 21(3), 455469. doi: 10.1080/13811118.2016.1222318.CrossRefGoogle Scholar
DeLong, E. R., DeLong, D. M., & Clarke-Pearson, D. L. (1988). Comparing the areas under two or more correlated receiver opearting characteristic curves: A nonparametric approach. Biometrics, 44(3), 837845.CrossRefGoogle ScholarPubMed
Dickstein, D. P., Puzia, M. E., Cushman, G. K., Weissman, A. B., Wegbreit, E., Kim, K. L., … Spirito, A. (2015). Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 56(10), 11271136. doi: 10.1111/jcpp.12385.CrossRefGoogle ScholarPubMed
Ellis, T. E., Rufino, K. A., & Green, K. L. (2016). Implicit measure of life/death orientation predicts response of suicidal ideation to treatment in psychiatric inpatients. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 20(1), 5968. doi: 10.1080/13811118.2015.1004483CrossRefGoogle ScholarPubMed
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187232. doi: 10.1037/bul0000084.CrossRefGoogle ScholarPubMed
Gipson, P. Y., Agarwala, P., Opperman, K. J., Horwitz, A., & King, C. A. (2015). Columbia-Suicide Severity rating scale: Predictive validity with adolescent psychiatric emergency patients. Pediatric Emergency Care, 31(2), 8894. doi: 10.1097/PEC.0000000000000225.CrossRefGoogle ScholarPubMed
Glenn, C. R., Kleiman, E. M., Cha, C. B., Deming, C. A., Franklin, J. C., & Nock, M. K. (2018). Understanding suicide risk within the Research Domain Criteria (RDoC) framework: A meta-analytic review. Depression and Anxiety, 35(1), 6588. doi: 10.1002/da.22686.CrossRefGoogle ScholarPubMed
Glenn, C. R., Kleiman, E. M., Cha, C. B., Nock, M. K., & Prinstein, M. J. (2016). Implicit cognition about self-injury predicts actual self-injurious behavior: Results from a longitudinal study of adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57(7), 805813. doi: 10.1111/jcpp.12500.CrossRefGoogle ScholarPubMed
Glenn, C. R., Kleiman, E. M., Coppersmith, D., Santee, A. C., Esposito, E. C., Cha, C. B., … Auerbach, R. P. (2017a). Implicit identification with death predicts change in suicide ideation during psychiatric treatment in adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 58(12), 13191329. doi: 10.1111/jcpp.12769.CrossRefGoogle ScholarPubMed
Glenn, C. R., Millner, A. J., Esposito, E. C., Porter, A. C., & Nock, M. K. (2019). Implicit identification with death predicts suicidal thoughts and behaviors in adolescents. Journal of Clinical Child and Adolescent Psychology, 48(2), 263272. doi: 10.1080/15374416.2018.1528548CrossRefGoogle ScholarPubMed
Glenn, J. J., Werntz, A. J., Slama, S. J., Steinman, S. A., Teachman, B. A., & Nock, M. K. (2017b). Suicide and self-injury-related implicit cognition: A large-scale examination and replication. Journal of Abnormal Psychology, 126(2), 199211. doi: 10.1037/abn0000230.CrossRefGoogle ScholarPubMed
Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. an improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197216. doi: 10.1037/0022-3514.85.2.197.CrossRefGoogle ScholarPubMed
Hengehold, T., Boyd, S., Liddy-Hicks, S., Bridge, J., & Grupp-Phelan, J. (2019). Utility of the “No response” option in detecting youth suicide risk in the pediatric emergency department. Annals of Emergency Medicine, 74(1), 1116. doi: 10.1016/j.annemergmed.2018.10.029CrossRefGoogle ScholarPubMed
Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., … Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 11701176. doi: 10.1001/archpediatrics.2012.1276.CrossRefGoogle ScholarPubMed
Hosmer, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression (3rd ed. Vol. 398). Hoboken, NJ: John Wiley & Sons.CrossRefGoogle Scholar
King, C. A., Grupp-Phelan, J., Brent, D., Dean, M. J., Webb, M., Spirito, A., … Casper, T. C. (2019). Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients. Journal of Child Psychology and Psychiatry, 60(10), 10551064. doi: 10.1111/jcpp.13087.CrossRefGoogle ScholarPubMed
Millner, A. J., Augenstein, T. M., Visser, K. H., Gallagher, K., Vergara, G. A., D'Angelo, E. J., & Nock, M. K. (2019). Implicit cognitions as a behavioral marker of suicide attempts in adolescents. Archives of Suicide Research, 23(1), 4763. doi: 10.1080/13811118.2017.1421488.CrossRefGoogle ScholarPubMed
Millner, A. J., Coppersmith, D., Teachman, B. A., & Nock, M. K. (2018). The brief death implicit association test: Scoring recommendations, reliability, validity, and comparisons with the death implicit association test. Psychological Assessment, 30(10), 13561366. doi: 10.1037/pas0000580.CrossRefGoogle ScholarPubMed
Nock, M. K., & Banaji, M. R. (2007a). Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. Journal of Consulting and Clinical Psychology, 75(5), 707715. doi: 10.1037/0022-006X.75.5.707.CrossRefGoogle ScholarPubMed
Nock, M. K., & Banaji, M. R. (2007b). Assessment of self-injurious thoughts using a behavioral test. The American Journal of Psychiatry, 164(5), 820823. doi: 10.1176/ajp.2007.164.5.820.CrossRefGoogle ScholarPubMed
Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010). Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological Science, 21(4), 511517. doi: 10.1177/0956797610364762.CrossRefGoogle ScholarPubMed
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168(12), 12661277. doi: 10.1176/appi.ajp.2011.10111704.CrossRefGoogle ScholarPubMed
Randall, J. R., Rowe, B. H., Dong, K. A., Nock, M. K., & Colman, I. (2013). Assessment of self-harm risk using implicit thoughts. Psychological Assessment, 25(3), 714721. doi: 10.1037/a0032391.CrossRefGoogle ScholarPubMed
Rath, D., Teismann, T., Schmitz, F., Glaesmer, H., Hallensleben, N., Paashaus, L., … Forkmann, T. (2021). Predicting suicidal behavior by implicit associations with death? Examination of the death IAT in two inpatient samples of differing suicide risk. Psychological Assessment. doi: 10.1037/pas0000980CrossRefGoogle ScholarPubMed
Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., … Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 11171123. doi: 10.1542/peds.2010-0852.CrossRefGoogle ScholarPubMed
Rossom, R. C., Coleman, K. J., Ahmedani, B. K., Beck, A., Johnson, E., Oliver, M., & Simon, G. E. (2017). Suicidal ideation reported on the PHQ9 and risk of suicidal behavior across age groups. Journal of Affective Disorders, 215, 7784. doi: 10.1016/j.jad.2017.03.037.CrossRefGoogle ScholarPubMed
Saito, T., & Rehmsmeier, M. (2015). The precision-recall plot is more informative than the ROC plot when evaluating binary classifiers on imbalanced datasets. PLoS One, 10(3), e0118432. doi: 10.1371/journal.pone.0118432CrossRefGoogle Scholar
Tello, N., Harika-Germaneau, G., Serra, W., Jaafari, N., & Chatard, A. (2020). Forecasting a fatal decision: Direct replication of the predictive validity of the suicide-implicit association test. Psychological Science, 31(1), 6574. doi: 10.1177/0956797619893062CrossRefGoogle ScholarPubMed
Supplementary material: File

Brent et al. supplementary material

Brent et al. supplementary material

Download Brent et al. supplementary material(File)
File 85.5 KB